Cystitis

Cystitis: Symptoms, Causes and Treatment (UK Guide)

Our main guide to cystitis in women: what it is, symptoms, causes, how it’s diagnosed, when it clears on its own, treatment, warning signs and repeat infections.

What is cystitis?

Cystitis is inflammation of the bladder. In most women it’s caused by bacteria, usually E. coli from the gut, getting into the bladder through the urethra (the tube you pee through). That makes it a type of urinary tract infection (UTI): a lower UTI, because it affects the bladder rather than the kidneys.

Women get cystitis much more often than men, because the urethra is shorter and closer to the bottom, so bacteria reach the bladder more easily. It’s uncomfortable but usually not serious, and it often gets better within a few days.

Less often, the bladder is inflamed without an infection, for example after radiotherapy to the pelvis, with some medicines such as the chemotherapy drugs cyclophosphamide and ifosfamide, or from irritating products. Antibiotics don’t help these types.

Symptoms of cystitis

Symptoms usually come on quickly, over a few hours. The typical ones are:

• pain, burning or stinging when you pee;
• needing to pee more often or more urgently than usual, including at night;
• feeling you need to pee again straight after going;
• cloudy, dark or strong-smelling urine;
• pain low in your tummy;
• feeling generally unwell, tired or achy.

Some conditions cause similar symptoms. Unusual vaginal discharge, itching or soreness suggest thrush or an STI such as chlamydia rather than cystitis. After the menopause, vaginal dryness can cause burning and frequency too.

Causes and risk factors

E. coli causes most infections. Other bacteria, such as Staphylococcus saprophyticus (more common in younger, sexually active women), Klebsiella, Proteus and Enterococcus, cause some of the rest. Cystitis isn’t caused by being unclean. A catheter, kidney stones or a problem with the shape of the urinary tract also raise the risk, and need a GP’s care.

Can stress cause cystitis?

There’s no good evidence that stress on its own causes cystitis. Long-term stress may make infections in general more likely, and some women notice that bladder symptoms feel worse when they’re stressed. If you have bladder pain and urgency that keep coming back with negative urine tests, see your GP: it may be bladder pain syndrome (interstitial cystitis), which isn’t an infection.

Cystitis in men

Men can get cystitis, but it’s much less common. In men, urine symptoms can be a sign of a prostate problem, a kidney stone or a narrowed urethra, so they need a GP assessment and usually a urine culture and a 7-day course of antibiotics. Our online cystitis service is for women only.

How cystitis is diagnosed

For women under 65 who aren’t pregnant and have typical symptoms, UK guidance lets a GP, pharmacist or prescriber diagnose cystitis from the symptoms alone, without a urine test. This is the basis for NHS Pharmacy First and for safe online prescribing.

A urine sample is sent to a laboratory for culture, which shows which bacteria are present and which antibiotics work, if:

• you’re pregnant;
• you’re 65 or over, or a man;
• your symptoms haven’t improved after treatment, or they come back within a few weeks;
• you’ve had 2 UTIs in 6 months, or 3 in a year;
• you have signs of a kidney infection, a catheter, or other health problems.

A dipstick test may be used when symptoms aren’t typical. If cystitis keeps coming back or doesn’t clear, a GP may refer you for a scan or a cystoscopy, a look inside the bladder with a thin camera.

Treatment

Self-care

Mild cystitis often gets better on its own within a few days. Paracetamol, or ibuprofen if it’s suitable for you, eases the pain, and drinking enough to avoid dehydration helps you feel better. NICE found no good evidence that cranberry products or cystitis sachets treat cystitis. Our guide to how to treat cystitis covers self-care, remedies and prevention in detail.

Antibiotics

An antibiotic helps cystitis clear faster. For women who aren’t pregnant, NICE recommends two first-choice antibiotics, both usually taken for 3 days:

• Nitrofurantoin, if your kidneys work well enough. Resistance to it is uncommon. See our nitrofurantoin guide.
• Trimethoprim, if the risk of resistance is low, for example if you haven’t taken it in the last 3 months. See our trimethoprim guide and trimethoprim side effects.

Most women start to feel better within 24 to 48 hours. If you don’t, or you get worse, contact your GP or NHS 111. Our guide to UTI antibiotics in the UK compares the options, including what happens in pregnancy and for men.

When to get urgent help

Contact your GP or NHS 111 (NHS 24 on 111 in Scotland) the same day if you have:

• a high temperature, or you feel hot and shivery;
• pain in your back or side, just below the ribs;
• nausea or vomiting with urine symptoms;
• blood in your urine;
• no improvement after 48 hours of antibiotics, or symptoms that get worse;
• urine symptoms and you’re pregnant, a man, or 65 or over.

These can be signs of a kidney infection (pyelonephritis), which needs different antibiotics and an in-person assessment.

Recurrent cystitis

NICE defines recurrent UTIs as 2 or more in 6 months, or 3 or more in 12 months. If that’s you, see your GP rather than treating each episode on its own. They can send a urine sample for culture, look for a cause, and discuss prevention:

• Self-care: drinking enough, peeing soon after sex and not holding on. The evidence is limited, but they’re safe.
• Vaginal oestrogen for women after the menopause.
• Methenamine hippurate, a non-antibiotic tablet that NICE recommends as an alternative to a daily antibiotic for some women. Evidence for cranberry is uncertain (and there’s none for older women), and D-mannose is a supplement rather than a medicine.
• A preventive antibiotic, either a low dose every night or a single dose after a trigger such as sex, prescribed by a GP and reviewed at least every 6 months.

Where to get treatment

• NHS Pharmacy First (England): many pharmacies assess and treat uncomplicated cystitis in women aged 16 to 64 for free, without a GP appointment. Scotland and Wales have similar pharmacy schemes.
• Your GP or NHS 111: for pregnancy, men, women 65 and over, repeat infections and signs of a kidney infection.
• Online: if you’re a woman aged 18 to 64 with typical symptoms, our cystitis treatment online service lets a GPhC-registered pharmacist independent prescriber decide whether you need an antibiotic, and which one.

Cystitis and UTI guides

Safety, confidentiality and free NHS options

Nitrofurantoin and trimethoprim are prescription-only medicines in the UK. Before anything is prescribed, a GPhC-registered pharmacist independent prescriber reviews your consultation, including your kidney health, the other medicines you take and any antibiotics you’ve had recently. We only prescribe an antibiotic when it’s appropriate: using antibiotics when they aren’t needed makes them work less well for everyone.

• Read the leaflet in the pack before you start.
• Don’t share antibiotics or keep leftovers for another time. Return unused tablets or capsules to a pharmacy.
• Report side effects to a pharmacist or doctor. You can also report them to the MHRA through the Yellow Card scheme.

Your consultation is confidential, and we only contact your GP if you agree. Access Doctor is a private service, and there are free NHS options:

• England: NHS Pharmacy First at a local pharmacy (women aged 16 to 64), your GP, or NHS 111.
• Scotland: Pharmacy First at a community pharmacy, or NHS 24 on 111.
• Wales: many community pharmacies can treat uncomplicated urine infections; ask your local pharmacy, or call NHS 111 Wales.
• Northern Ireland: your GP, or a community pharmacy for advice.

If you’ve had 2 urine infections in 6 months, or 3 in a year, see your GP rather than ordering again online. A urine culture can show which antibiotic will work, and your GP can look for a cause and talk about prevention.